Infant sleep problems: A troubleshooting guide

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Struggling with infant sleep problems? You aren’t alone. In a massive, international survey, researchers found that more than 25% of parents living in Western countries complained that their young babies or toddlers had sleep troubles. Among parents living in East Asian countries, the number was even worse — over 50% (Sadeh et al 2011)!

Why are these complaints so common? In part, it’s a reflection of the conflict between developmentally normal sleep patterns and the needs of parents. Babies aren’t born “good sleepers.” They need to awaken frequently to feed, and it takes time for them to develop mature sleep rhythms. Indeed, studies suggest that we shouldn’t expect babies to sleep for more than 4-5 hours at a stretch until they are at least 3 months old.

Is this natural? Healthy? Sure. But if you need to go to work in the morning, it’s a reality that can leave you exhausted.

The situation gets even worse if our babies have trouble falling asleep in the first place. Yet we shouldn’t feel hopeless. On the contrary, there is a lot we can do to improve our lives.

For example, some babies sleep poorly because they have a medical condition, so you might want to review these common infant medical problems that interfere with sleep. And if your baby isn’t unwell? This article can help you identify common behavioral causes of disturbed infant sleep.

Here is a list of ten things that might be going wrong, and what you can do about them. At the end of the list, I talk about a controversy that every new parent gets confronted with — the “cry it out” controversy. Then I sum things up with a checklist of good practices for avoiding infant sleep problems.

1. Not drowsy at bedtime? It might be because your baby’s internal clock is out of sync with the 24-hour day.

First things first: Does your baby appreciate that nighttime is for sleeping? If not, you’re fighting an uphill battle. Most infants don’t develop strong, hormonally-driven circadian rhythms until they are 12 weeks old, and some babies take considerably longer (Jenni and Carskadon 2005; Jenni et al 2006).

You might assume that this is one of those developmental things we just have to wait out. But that’s not quite true. The evidence suggests we can help young babies attune themselves faster. If we lay the right groundwork early on, we may avoid some infant sleep problems later. Be sure to try these tactics:

  • Support your baby’s tendencies to wake up at the same time each morning, and expose your baby to daylight during the morning and afternoon.
  • Include your baby in everyday activities. The hustle and bustle of social life helps set your baby’s inner clock.
  • Avoid exposure to artificial lights before and during bedtime — particularly LED lights and other light sources that feature light from the blue part of the spectrum.

Experiments show that blue light is particularly effective at blocking the brain’s production of melatonin, a hormone that promotes sleepiness. A little exposure to blue light can delay sleepiness for an hour or more, and it affects adults as well as children.

Read more about artificial lighting — and how to cope with it — in this Parenting Science article about the effects of light-emitting entertainments and devices. Tackling blue light exposure can improve the sleep of everyone in your family, so it’s worth taking seriously.

For more tips, see the section about circadian rhythms (“How to help baby adapt to the 24-hour day”) in my article about newborn sleep.

2. Is your baby waking up because of hunger?

As mentioned above, newborns sleep in short bouts, and there isn’t much caregivers can do about it: They need frequent feedings in order to grow and thrive. But you might be able to improve your own sleep quality with a couple of nighttime feeding tactics.

The first is called “dream feeding,” a technique in which you provide your baby with a big meal just before you attempt to fall asleep for yourself. The idea to help your baby “tank up,” so your baby (and you) will sleep a bit longer. And the second involves introducing brief delays before beginning those middle-of-the-night feeds.

For example, instead of feeding your baby immediately, you might change your baby’s diaper first. As babies get older, this delay might help them break the association between night wakings — which all babies experience — and feeding.

Do these tactics work? An experimental study suggests they do.

Researchers recruited 26 families, and assigned half the parents to offer their babies a big meal between 10pm and midnight. They were also told to avoid feeding babies immediately after they woke up during the night. In addition, parents were instructed to expose their babies to strong cues about the natural, 24 hour day.

The intervention appeared to be very successful. Eight weeks after training began, 13 out of 13 infants in the treatment group were sleeping quietly from midnight to 5am (Pinilla and Birch 1993). Only 3 out of 13 control infants were doing so.

It sounds promising, but keep in mind: This is a small study that needs replication. Moreover, the study design doesn’t permit us to tell which of the interventions were important, and we don’t know if the effect was long-lasting. It’s also unclear if going 5 hours without feeding is in the best interest of every 8-week old infant.

But as long as your baby is getting enough food and fluids — and your pediatrician approves — these tactics are worth trying. For more information about nursing young babies, see this Parenting Science article about feeding infants on cue. And if you are interested in trying out dream feeding, check out my evidence-based guide to dream feeding.

3. Is your baby is overstimulated?

Rambunctious play and energetic talk can rev up your baby’s sympathetic nervous system—the system that keeps us alert. So if the hour leading up to bedtime is too exciting, your child might have trouble switching into drowsy mode.

Similarly, babies may become overstimulated by electronic media, and not only because they deliver exciting content: Electronic screens emit that blue light mentioned above — the part of the light spectrum is especially likely to delay the onset of drowsiness.

And while I haven’t found any experiments that prove the point, researchers around the world have noticed correlations between screen time and sleep in infants and toddlers (e.g., Lin et al 2022; Ribner et al 2019; Chen et al 2019; Kahn et al 2021). Moreover, it’s worth noting that hand-held devices (like phones and tablets) might be at least as disruptive to young children’s sleep patterns as television is — if not more so.

For example, in a survey of 715 British parents, researchers found that babies who spent more time playing with touch screens (on phones and other devices) took longer to fall asleep at night. In addition, these babies also had shorter nocturnal sleep times. For every additional hour that an infant used touch screens, the infant was likely to sleep 26 minutes less at night (Cheung et al 2017).

The takeaway? You might find it easier to get your baby to sleep at night if you reduce sources of evening stimulation, including rambunctious play and electronic media. Some researchers have recommended that parents make the last 2-3 hours before bedtime quiet and calm (e.g., Glaze 2004).

4. Is irregular timing — or a lack of routine — is making it harder for your baby to settle down?

Young children may sleep longer at night when they observe regular bedtimes (Staples et al 2015). Research also suggests that children fall asleep faster, and spend less time awake at night, when their parents implement a consistent bedtime routine at night — like bathing, quietly dressing for bed, and reading a bedtime story (Mindell et al 2015).

So if you’re struggling with infant sleep problems, it’s worth introducing a bedtime routine. Indeed, in experimental studies, parents have improved infant sleep problems after introducing bedtime routines (Mindell et al 2009; Mindell et al 2017). Learn more about how to implement a bedtime routine here.

But are regular bedtimes really necessary to avoid sleep trouble? 

Cross-cultural studies suggest otherwise. In many parts of the world bedtimes are fluid or irregular, and babies go to sleep without much fanfare (e.g., Morelli et al 1992; Ottaviano et al 1996). Moreover, researchers (e.g., Yetish et al 2015, supplement, table S4) have noted substantial variability in the bedtimes of adults living in hunter-gatherer societies — the peoples whose life-ways most closely resemble those of our ancestors. And hunter-gatherers are remarkable for their lack of sleep complaints (Yetish et al 2015; Samson et al 2017).

It’s evident, then, that there is more than one way to achieve healthy sleep patterns. But before you conclude that anything goes, keep in mind these crucial points.

First, irregular bedtimes can cause trouble if they lead to irregular morning wake-up times.

If you wake up at different times each morning, it can disrupt your circadian rhythms. Maybe that’s why anthropologists have observed morning regularity among hunter-gatherers: They tend to get up at the same time each morning regardless of when they fell asleep the night before (Yetish et al 2015).

Second, babies who experience irregular bedtimes tend to get less sleep at night — a deficit they’ll need to make up during the day.

This isn’t perceived as a problem in many traditional societies, where babies are expected to take short daytime naps while being carried in a sling. Parents, too, may sometimes take naps to compensate for a short night’s sleep (Worthman and Melby 2002; Samson et al 2017).

But if your schedule doesn’t permit this flexibility, irregular bedtimes could leave you short-changed. So it really isn’t anything goes. Babies and adults alike benefit from waking up at the same time each morning, so that’s something to aim for. And when irregular bedtimes lead to shorter nighttime sleep bouts, be prepared to make up for lost sleep during the day.

5. Is your baby’s bedtime is too early? Or too late?

When should babies go to bed? It can be hard to figure out.

Some parents overestimate infant sleep requirements, or try to force bedtime on an infant that isn’t sleepy.

That’s bad for a couple of reasons. In the short-term, the baby resists bedtime, and everyone is unhappy. In the long-term, your child is learning to associate bedtime with the failure to fall asleep. It could be a recipe for developing bedtime resistance and insomnia (LeBourgeois et al 2013).

Other parents keep their babies awake too long, making their babies irritable.

It can be an easy mistake to make, especially if your baby seems very active and energetic.  Isn’t that proof that your baby isn’t yet ready for sleep? Maybe, but there is another possibility: Your baby might be hyper-reactive or “overtired.” If so, you’re baby’s behavior is deceptive: He’s not alert because he’s well-rested. He’s alert because his stress response system is stuck on high gear. 

What to do? If you’re uncertain, review these signs of infant tiredness, and consult this Parenting Science article about the range of sleep times observed in normal, healthy babies. It will help you home in on your baby’s needs.

Then, if you suspect your baby’s bedtime is too early, try this gentle infant sleep training solution, called “positive routines with faded bedtime.” It’s safe to use, and doesn’t involve any “cry it out” tactics.

If overtiredness is the problem, pick an earlier bedtime, and help your baby wind down by introducing some soothing, low-key bedtime rituals.

6. Are you too quick to intervene when you think your baby has awakened?

Babies sometimes make noises — and may even cry out — when they are still asleep or only partially aroused. They may also thrash around quite a bit.

In other words, babies are restless “sleep talkers.” And this makes it’s easy for newbies to misinterpret what’s happening. They mistakenly assume that their babies are awake and signalling for attention. So they intervene — touching and talking to their babies — and they end up doing the very thing they most want to avoid: They’ve awakened a sleeping infant!

That’s one reason to be cautious before interacting with your baby. And here’s another: Video recordings of sleeping infants reveal that babies as young as 5 weeks can spontaneously resettle themselves after waking up in the middle of the night (St. James Roberts et al 2015).

During the study in question, babies sometimes went back to sleep quietly. In other cases, the infants cried or fussed briefly (for about one minute) before going back to sleep on their own (St. James Roberts et al 2015).

But either way, these babies fell back to sleep on their own, without coaching or marked distress. That’s the sort of thing you want to promote.  

So intervening too soon can backfire. You think you are being proactive, responding quickly so your baby will be able to go back to sleep quickly. But instead you are awakening a sleeping baby, or interfering with a drowsy baby who was about to nod off. Ouch. To avoid becoming the cause of infant sleep problems, don’t jump in at the first signs of movement or noise.

7. Are you making those middle-of-the-night care sessions too interesting?

We’ve seen how too much stimulation can cause trouble at bedtime. Parents can also cause infant sleep problems by creating too much excitement after a baby has awakened during the night. Babies are social creatures, and are easily stimulated by talk and other forms of communication. So it doesn’t take much to turn a sleepy baby into an alert baby. Eye contact alone can do it.

Thus, to help your baby to go back to sleep quickly, avoid eye contact and conversation. As you tend to your baby’s nighttime needs, keep things comforting, but dull and quiet. And don’t forget to avoid those artificial lights! Keep things as dark as possible.

8. Are you being inconsistent in the way you respond to your baby?

It’s easy to get off-track when you are frustrated or tired. Sometimes you might use overly-stimulating soothing techniques. Other times — when it seems that nothing works — you might withdraw from your baby altogether (France and Blampied 1999). It’s human nature, but it’s confusing for the baby, and it can make infant sleep problems worse.

To help avoid this scenario, take the time to create a single, consistent approach to your infant sleep problems. Research the science of infant sleep patterns, and decide what approach is best for you and your baby.

Thinking things through ahead of time will help you stick to the plan, and may have additional psychological benefits for you. Parenting studies suggest that getting informed can boost your sense of competence and confidence, and protect you from feelings of frustration and despair (Heerman et al 2017).

9. Is your baby is napping too late in the afternoon?

Naps are good for babies. Among other things, they help infants “download” newly learned information into long-term memory (which you can read more about in this Parenting Science article).

However, there’s no denying that napping long and late into the aftenoon can interfere with nighttime sleep. That’s because sleep pressure (the physiological urge to sleep) builds up the longer we’ve been awake. So it shouldn’t surprise us if a baby — having awakened from a lengthy nap only a couple of hours earlier — has trouble falling asleep at bedtime.

If this seems to be the trouble, try extending the last waking period of your baby’s day.

That may seem hard to do if you’ve got a drowsy baby at 5pm; but remember, you don’t have to arrive at the perfect schedule all at once. You can work towards the goal in steps, trying to make the last nap of the day end at an increasingly earlier time over the course of a week or so. When parents have managed to lengthen waking time before bedtime, their babies have required less help settling down and experienced fewer infant sleep problems (Skuladottir et al 2005).

10. Does your baby know how to self-soothe?

Sleep science has proven the point: Everybody wakes up during the night, and we do it quite frequently, even if we don’t remember these wakings the next day. So eliminating night wakings isn’t a realistic goal. Rather, we should focus on making night wakings less disruptive.

As mentioned above, research shows that babies sometimes resettle themselves without becoming stressed or waking up other people. What can we do to promote this behavior?

One crucial tactic, noted above, is to stop undermining these spontaneous acts of re-settling. Don’t jump in prematurely. Your baby might actually be asleep, or on the verge of falling back to sleep on his or her own. By intervening too soon, you can create infant sleep problems.

But can we go further? In some Western countries parents are advised to avoid soothing their babies to sleep. For instance, Richard Ferber argues that parental soothing trains babies to associate sleep with parental intervention (Ferber 2006). As a result, children don’t develop their own, self-soothing abilities. When babies wake up during the night (and all babies do), they cry until their parents come to their aid.

The remedy, according to this argument is to follow certain rules. Don’t let the baby fall asleep in your arms. Instead, at bedtime, put your baby to bed before he or she has fallen asleep.

What does the research tell us about putting babies to bed when they are drowsy, but still awake?

When babies fall asleep at the breast — or are put to bed after they have fallen asleep — babies may be less likely soothe themselves back to sleep when they awaken again during the night (e.g., Anders 1979; Anders et al 1992; Ferber 1986; Goodlin-Jones et al 2001).

For example, consider a recent study, in which 20 babies were fitted with nighttime sleep monitors, and had their sleep tracked at various points throughout the first 6 months of development. The researchers found that babies were more likely to experience “infant-only wake bouts” (where they resume sleeping by themselves, without awakening their parents) if they weren’t habitually fed back to sleep during night awakings. Moreover, once babies reached 6 months of age, these infant-only wake bouts were more common among children who were put to bed while still awake (Adams et al 2022).

Consistent with this research, other studies report that parents who feed, hold, or rock their babies to sleep tend to report more night wakings (Anuntaseree et al 2008; Mindell et al 2010).

But what if babies cry?

If you want to reduce the number of times that your baby awakens you at night, then reduced parental soothing at bedtime might seem like the way to go. But there’s an obvious complication: Babies often cry or protest when caregivers withdraw.

It’s a natural behavior. Throughout human history, babies have stayed in close proximity to their caregivers. Being left alone meant something was wrong. A baby was at risk for neglect, abandonment, or predation (Hrdy 1999).

So it’s little wonder that our ancestors evolved emotional and behavioral responses to separation — responses that would help ensure that babies stayed close (Panksepp 1998). What, then, should we do when babies cry?

Ferber has proposed his own solution, which I review here. In a nutshell, his idea is to leave the baby alone for increasingly lengthy intervals, ignoring cries, until the infant learns to give up (Ferber 2006).

It’s not intended for very young babies. Researchers warn that such sleep training should not be attempted until infants are at least 6 months old (Owens et al 1999; France and Blampied 1999). Moreover, the American Academy of Pediatrics recommends that parents share a bedroom with their babies for at least six months after birth because it may lower the risk of SIDS, and “facilitate…comfort and monitoring of the infant” (Moon et al 2016).

But when it comes to making nighttime easier for parents, this method — called “graduated extinction” — has a successful track record. Babies become less likely to cry in the middle of the night when they awaken. Caregivers report fewer infant sleep problems.

This can be a relief to desperate parents. But it’s important to understand: When researchers compare the results of controlled, randomized experiments, they find that other methods of sleep training — methods that don’t involve leaving infants alone to cry — are just as effective as graduated extinction. Parents and babies have experienced similar sleep improvements whether they used graduated extinction, or an alternative, evidence-based, “no cry” approach to sleep training (e.g., Matthey and Črnčec 2012; Park et al 2022; Blunden et al 2022).

Moreover, if your baby suffers from separation anxiety, experimental evidence suggests that you’ll have more success with a gentle approach called “extinction with parental presence,” or “camping out” (Kahn et al 2020). Read more it in my article, “Infant sleep training: Gentle alternatives to ‘cry it out’. “

These points matter, because many parents find it too distressing to ignore their infants’ cries.

It feels wrong to them, and they may worry about the possible, negative effects of enforcing the central features of graduated extinction — (1) leaving babies left alone, so that they unable to perceive the immediate presence of caregivers, and (2) requiring parents to act as if they are insensitive to the baby’s distress. Major media headlines to the contrary, experimental studies haven’t yet supplied us with strong evidence about these concerns.

Do “cry it out” tactics cause negative side effects?

To date, I’m aware of two experimental studies that attempted to test for the existence of lasting, negative, behavioral effects on infants. And while these studies are sometimes cited as evidence that leaving babies alone to “cry it out” is problem-free, that’s very misleading. In reality, we can’t reach any firm conclusions.

For example, the first experimental study tested the long-term effects of sleep training on more than 170 babies, but did so by lumping together several different training strategies, including a program that didn’t involve leaving infants alone (Price et al 2012).

Thus, we can’t know if families who used graduated extinction experienced different outcomes than families who used other methods — like those that kept babies and parents together in the same room.

In addition, this study failed to determine if parents in the control group also attempted sleep training (i.e., on their own, without being coached by the experimenters). This, too, is crucial, because it means we can’t draw conclusions about the lack of detectable differences between groups. Maybe outcomes were similar because treatments were similar: Babies in both groups were exposed to a mixed bag of sleep training techniques.

A subsequent experimental study suffers from similar interpretative problems (Grandisar et al 2016). The researchers took the helpful step of distinguishing between graduated extinction and other types of sleep training. But they didn’t measure what parents assigned to the control condition did with their babies. Nor did they keep track of where babies slept with respect to their parents — alone or in a shared room.

Moreover, this was a much smaller study, and one marked by substantial amounts of missing data, as well as some discrepancies in the published numbers. For example, at one time point during the study, almost half the families failed to participate. Researchers filled in the missing data with their own estimates (Grandisar, personal communication).

So — as I write this in September 2023 — the experimental evidence is inconclusive. What about other evidence?

Based on non-experimental data, caregivers tend to perceive similar outcomes in their well-being — and in parent-child bonding — regardless of their preferred approach.

In a survey of more than 2,000 respondents, researchers simply asked parents if they had ever tried any type of sleep training at home, and, if so, what was the experience like? How did things turn out?

Some parents said they had tried “cry it out” strategies (like graduated extinction). Others said they had tried a “gentle” alternative (i.e., “camping out,” where the caregiver stays in the room). Parents who reported having used “cry it out” tended to estimate that their babies’ subsequent, nighttime sleep bouts were longer, which makes sense if their babies had learned not to vocalize during night wakings. When we don’t hear our babies crying at night, we’re more likely to assume that they are sleeping uninterrupted.

But this was the only response about long-term outcomes in which the two groups varied. The researchers found no differences in terms of “parent sleep, sleepiness, depression, or parent-infant bonding” (Kahn et al 2023).

How do we interpret these results? From the standpoint of self-selecting your own solution — and feeling comfortable with the outcomes — I think they are reassuring. When parents freely chose what type of sleep training to use (rather than being randomly assigned to carry out a particular approach), they didn’t show any group-based differences in parental well-being — such as sleeping longer at night, feeling less sleepy during the day, or experiencing depression. Nor did they show group differences in their perceptions of their babies’ attachment relationships.

A similarly reassuring piece of evidence comes from a longitudinal study, where researchers tracked child outcomes from birth to 18 months.

Once again, parents who freely chose to employ “cry it out” strategies didn’t report higher rates of behavioral problems over time. Nor did researchers observe any differences in behavior or attachment security (Bilgin and Wolke 2020).

It’s also evident that babies don’t need to sleep alone in separate room to develop quieter sleep habits.

For example, in places like Hong Kong, babies and children often share a room with others.  In some cases, they share a bed with a parent. But researchers have found no links between sleep location and night wakings (Yu et al 2017).

So it appears to be the use of active soothing measures — like feeding or rocking a baby to sleep — that can interfere with the development of self-soothing. Not necessarily parental presence.

And keep in mind the work of Douglas Teti, who has found that one of the most important predictors of infant sleep problems is whether or not parents are emotionally available at bedtime — responding with sensitivity to a baby’s needs, and projecting a calm, reassuring mood (Teti et al 2010). Regardless of whatever else you might do, and whatever sleep arrangements you adopt, maintaining emotional availability at bedtime can help your baby settle down.

Putting it all together: A checklist for coping with infant sleep problems

  • Establish regular day-time cues. Make sure your baby is exposed to natural daylight and daytime activity. Include baby in the daily hustle and bustle.
  • Establish regular night-time cues. As bedtime approaches, shift down from stimulating activities to more passive, sleepy, sedate activities. Dim the lights. And consider introducing special bedtime rituals, like reading bedtime stories or singing lullabies.
  • Tank up before bedtime. As noted above, babies may sleep for longer stretches at night if you feed them shortly before bedtime.
  • Keep your nighttime interactions calm and low-key. Be responsive, but boring. Avoid making noise, avoid moving your baby around, and avoid eye contact. Some infant sleep problems are caused by parents making too much of a fuss.
  • Watch out for intervening too quickly when you think your baby has awakened. You might end up awakening a sleeping baby, or preventing your baby from falling back to sleep spontaneously.
  • Consider implementing a consistent bedtime routine — one with a regular bedtime, and the same, soothing, “wind-down” activities each night.
  • If your baby is over 6 months old, consider these gentle sleep training programs. Because they don’t require babies to fall asleep alone, they minimize distress for both parents and infants. If you think your child has separation anxiety issues, choosing a “gentle” approach may be particularly helpful.
  • If you’re worried about a possible medical problem, or something just doesn’t seem right, talk to your doctor. Most infant sleep problems aren’t caused by medical conditions, but some are. Read more about it in this Parenting Science article.

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Content last modified 11/2023. Portions of this text are derived from earlier versions of a Parenting Science article with the same title, “Infant sleep problems: an evidence-based guide.”


image of tired father watching TV with infant by Ghislain & Marie David de Lossy / istock